HomeMy WebLinkAbout11_16_1981 - 20948 MOONLAKE ST (3) , . _ _,... .._. _ __ .._ __ . __ - _..
y , ```. GI,� G
` ��NORKER$'COMPENSATION DECLARATION' � . .� ' '..... - .� -. . - . . . . . _ . .
� insureborac�ertifimtelofWorkeseCompanslionln�°a��a°o'�� — � .- APPLICATION: FOR BUILDING PERNIIT �
�
a certified copy the�eof(Sec.3800,Lab.C.) __ . - - � � COUNTY OF L�OS ANGELES� � BUILDING AND SAFETY • �
PolicyNo. Compony ��.�`�; � �� � BURDiNG -
�, Ce"rtified topy is hereby furnished: ' ,' FOR'APPUCANT TO F,ILLIN �- nooseSs �OG
.� ��Cerlified copy is filed wi�h the�county butlding inspeo- eURDwG �' .
tian deparfinenf. ' _ ADDRESS 1I oN�!}.Y LOCAUTV l+�
� - t - _ ` - _ NEAREST /w/� ��G/
Dote Applimet � ' -�'�' �ITY"�- 1JT j !'.:ZIP' CROSS ST. �V 4 �
�� �CERTIFICATE OF EXEMPiION FROM WORKERS' � � �`-�• � NO OF BLDGS:-��,� q ASSESSOR
� � - � �COMPENSATION INSURANCE� � � SIZE OF tOT'f"a��'��j"•i--��--�1�NOW ON LDi��L`��1 MAP BOpK PAGE PARCEL
��This settion need-not be tompleted if the permif is for one � / O u5E ZONE nwP �
hundreddollars(EI00)orless.) . TRA�T�27'3�J -. BtOCK, iorr�o. �J . No. ��� ���.J 3 �,
t /. � 1GL. . SFECIAL o„
I te�tify Ihat in the perFormance of the work for which this; OWNER P�p T l(I/1v0. - - � CONDinONS �� � � _
permit is fssued,I shall nol employ any person in any manner� e j�§TgyQ GROUP TYPE fIRE PROCESSED BY {,J
' sa os 10 6ecome subject to the Worke�s'Compensotion Laws. ADDRE55 Q Q L/T �/1 i`/� CON�- ZONE ` �
, . �� �3 ,I /h yP.�� o,
Date -� APPIiCaM � . . � .� CITY (J! 21F. I STATISTIGI�C1A551FICATION� . APT. ' CONDO. V
NOTICE TO-APPUCANT: If, ofler moking ihis Certificote of' � ARCHITECT OR -� - TEL. ��� W
Exemption,�you'should become subjeu �o ihe Workers' � ENGWEER NO. CLA55 NO.' �WEIL UNITS N ,
Compensation provisions of ihe Labor Code,you mvst fonh-�� - qDDRESS - � � � � SEWER P - i ?
with comply with suth provisions or Ihis permit Sholl be ' TEL. � /a�
deemed revoked. . . . • �, •- - � �ONTRACTOR � �-�- � � � �NO. ' -- - e���• � VAIIDATION
�-LICENSED CONTRACTORS DECLARATION . - - �I�. . . .
I hereby affirm that I am licensed onder provisions of Chapter9 �. �. AD�RE55._ __ �NO.- yp���� "!
(mmmencing with Settion 7000)oF Division 3 of the Business and , i��. Q .
Professions Code,and my Iicense is in full force ond effecl. . _ _ CITY ClA$$ S '
- - ' - . . $O.FT NO.OF NO.Of CHECK - " � -
License Number � Lit.Class SIZE STORIES FAMIUES ONE � . �
" . N� O .S . . .
Conlracfor pofe ' DESCRIPTION OF WORK .
� I am e empt from the licensing requirements as I am a � -" ADD � � �
licensed architeU or a registered professlonal engineer'- _ _. __ _ ALTER Q FINAL � G� h�
actlng in my prafessional capatity (Settion 7051, � � � � DATE �.�^ —p� .� �� ^�; -
� Business and Professions Cade). � � USE OF . � REPAIR ,��
n t s t
� EXISTING BIDG. �� � � " DEMOL � FINAL � . � n�r t:(�
�i[.Or Re N0. DotB APPIICANT Te�. t7 er q;,�i�7���je!'.
9 ' PRINT' J�/5�7� ' .
- '`�- OWNER-BUILDER DECIARATION - ' � , � T � ' "NO. �n, „y'^ � j��lj ��/�
I hereby otfirm thaf I om exempt from the Contractor's License. oC /V F
Low ior the fallowing reoson(Section 7031.5, B�siness ond� � /+�DUE55 �9� dd��fr� /�`C r/
Pro ssions Code): � � - . _ ckESENi , . _ . . ' ' ,
BUIIDING .
I, as owner bf fhe property, or my employees wifh ADDRE55 �x ��_lQ—��-
wagez as fheir sole[ompensafion,will do the work and � ,
- the strucfvre is not(ntended or offered for sale(Seclion- - � �OCAtI7Y - �- - �� - -- - - ----��-- - � ' � � - -� '
7044,Business and Professions Code). MOVING iEL . .�� -��f•+ � � ,
- � I,as owner of the property,am ezdusively conlracling, ' �ONTRACTOR NO. �
with licensed cantractors ro constroct ihe project(Sea qDDRE55 � ' " � �
tion 70d4,8usiness and Professions Code). -� - - �
REQUIREO TOTAL$ETBACK FROM EXIST. { � � �, I
CONSTRUCTION LENDING AGENCY SEi BACK �AR� HWV pROP.linlE' WiDTH � . � , �' . . �
- . ';... • i, ,`
� I hereby a(firm ihat ihere is a constrodion lending agency for �" FRONT q � ,� � �
Ihe pe�formance of Ihe work for which lhis permit is issued P.l. L'���GA/C _� ,,,.�,- _ l �� � .
ISeC.3097.Civ.C.). , . . .SIDE. . . . . _ � - �_ . .., --i `'�. ��. :! .
� _ . .._ ._ . . � • � -
' F.L. .. __. ... � .
Lender's Name � , '_ _ _ '__. . , . _ . . . ..
� � � P.C.Fee S Perm�t Fee � '
lender's Address � _ . . _ . _. _ _ ,. ._ ..� . . /
I certify thot I have reod ihis opplimfion and state lhat the Issoan<e Fee 'S�U /
obove information is correc�.I agree to comply with all Counry . in.esrgai�on fee � �� � - �� - � �� � � /
ordinonces and S�ate bws reloting to building constructian, Torol Fee /� s� � �
� and hereby authorize represen�aiives af this Coumy to enrer: , ' - I
:'"upon ih above-mentioned properry foyr(i/nspection pu�poses. � � � � ' � , ' , ',r�'
Ly��a.�.lMaL �LLl�-�f SFE REVERSE FOR EXPIANATORY LANGVAGE ' " . , �Y
,Signorure af p limnt or Agm� Do�e ! � � � � (
. . .. .... . ... .. . ., �- ._. . ..,.. , ' .. .,.. .. _ . .. . �. �
Q O
- -.'$� . � � � _ . .
�- -✓ .,n 'Z O . , ', .
. � o a �
�.o m p Q s f� ,y p
' .- C�� �a o � 'o Q � t' o ,
O O n. �~.'. �' � p ,O i+ � � "O
� �, �
F: � .`•..° na ¢ �� '3 m �' 2
r' - 9 fl• i-? 9 -O i N , ' '.
N o �Q `O � 3'q� oo ' . � ' �
- � a y 6 '3" co o ^,. �� ' Z O
r y 4 � p. °� � , �o o ° ' . Fa
,� o m m o r' � o _ „�> >
y o s �o o a� t .- p �
��'p G ; j Q -� N p 4, ' �L „C A � � �1
m� iro o r� �•i v ~ ' o: N D fl o �Z
�� �x � o° � � � o � p. �
o °�m ° ` � . 2 °�
� p�
O-� �� p .
� � �/� p _
V� � q
I ' ,
p O a
,�y � � "� , ' �� . L
fX! . � .p n , W .
\ ; L 1 • �
� . , , p � .
� p"�
w '
O '
� � �
w '
� r /� �
S" ..
I �
' A. ., fn
� f ' �
� • �l� : �
, � � � .
1 ' + �/. r � , `
• v,. �
', � , ,
� " " � .
1
� ` �, ', � .
' � o �� 'n s +
c�-•,��. � m
�, p .
. . • A�q�� !1�'P'V'?�� m {O .
. �,w.�,�,Q,� ;a� N��v�p.� po r�4 .Y 4 A'�' =`�"��
' � Q'�.tcoo �p o .�o._�rs"� p - o n�" o����»,o o3 �'j''
,,t-� ��-c �'-s�e, � ��c'r o „ .�.'v fl ''^t, «.�..x �, o '� ...,,-, 'S CJ
. � b C C'O� a b aQ^o C �,II'O �'.. ts G...S�' o w`O i'S'C}io e'�-t �~ 'G' 3 Q✓
^�i A 6 n m C .-�t /9 O �-w.. e c t-�A.e. O
O� a Ai�t . � �h-� � E'�10„w�v;�'� -�t O Tn'�•i� s��,� ^ � � J�
� Q � Q � h�� C'�i �'� O„""O �n..N Tn���p b 7 o'w O Sa �' ���E ��:� �7�.� O'� C4
v � 'M1 C N p N h} 75 W � O H«C7�O O,m �t~4�l 0 �.N. .'t�K"v�b F Cl�m "�
c7
� � a �.°��.3� � � f'`°'M"�e `»� �so�i�.�o.sA���ob�3 ���.7� q�
r
� �, m t-'�on P°-^ 00:.?�`�"� Q o��m%`^•�°�a^p"' ° g� '-�iO�°r
, ' � n A C 3 t� O„"'3' � ��,� (�p..S�e 6 "-" � .d++� m v'f�' �Ti7`'�io'�L p ���
- l ' . . ' � -3 O � O vd� S• "�-t io�L.� D p,O a�t0 L`+»O �p ii R? �p ii.' �S. O 3
. . 'D Q '� E. � p m E' �3 p LT'� e� �Q R i.. � Y � O p� '3�G:� � .
7 .fl, e�o'�v'Aoo w��Q,� o � y�7^1 �o x� C, ���� �..oOr
A�t'."�w 4 W
, m � o c ti'^ N'a �:�°� '�g.c„�,c�a co 4. A�y„,a o a� '° o a=' c o',� C'�'2.
' �O N y� A � v� n':' �i.Q'�' � G t'� C o CY'� O�^-p m P.�p p'p ?.w n �
� , n' _ Ai, . r,�n,� n 7 o a �•�,°.�..,�u,,�.V� � o m --;' � a�b�`'^� n s K �° ,s.
� p A � oo�,,�� �. ��.�a��� mm�� �o�L.',�,�.�j�o �.�o
�' ' � � 7� m��:° �.n� �.~ o Q'C'-�`� o r 4.°c tn° .w-o�'F C''n m 't L'C�-,W'a
`. Z -o° „�m '"_ ��--������,s„N�o N o��,�o�° ��-
� O 'O � o� f1-o a 'e'g ir Q i^r�a-� m o? .: "'-;e,� a�.
� . ' . � 7 � �s. =+n P x� n . .�o ? ;' `��" �.q.S . .
\�. . .. . . m Q°p � •Y..,,.i v �7' m o o., � t°
. e� p 4 r. ....,�L....+y,,,++.x�. �t
_ n .��i �+ � � � e+'
'` 0 � � �!,',�
.- - . O L„C a a'
� .�
N '